Grading and Staging Kidney Cancer

Once your health care provider knows you have cancer, the next step is to find out the grade and stage of the cancer. Stage is a way to note the size of the tumor, and if it has spread. Grade is a way to note how abnormal the cancer cells look under a microscope. Staging and grading of cancer is important for deciding how to treat it, and how curable it is.

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Grades of kidney cancer

The grade refers to how the cancer cells look when compared to normal kidney cells. The grade of your cancer will help your health care provider predict how fast the cancer may grow and spread. The Furhman scale of 1 to 4 is used to grade kidney cancer. The lower the number, the more the cancer cells look like normal cells. This means the cancer can be more easy to treat and cure. This is because cancer cells that look more like normal cells tend to grow and spread slowly. Grade 4 cancer look very different from normal kidney cells. This grade of cancer is harder to treat.

Stages of kidney cancer

The stage of your cancer describes the size of a tumor, and how much it has spread. Health care providers use different rating systems to stage cancer. The American Joint Committee on Cancer (AJCC) staging system is used most often for kidney cancer. It’s called the TNM system.

• T stands for tumor. This category notes the size of the tumor and if it has spread into nearby areas.
• N stands for nodes. Lymph nodes are small organs around the body. They help the body fight infections. This category notes if cancer cells have spread to the nearby lymph nodes.
• M stands for metastasis. This category notes if the cancer has spread to other organs in the body. This may include a lung, your bones, liver, or brain. It also includes lymph nodes that are not near your kidneys.

Numbers from 0 to 4 are assigned to the T, N, and M categories. Once your health care provider has determined your T, N, and M values, he or she then determines your stage grouping. The lower numbers mean smaller cancers and that are easier to treat and cure. Here are the 4 stages of kidney cancer:

Stage I. The cancer is found only in the kidney. It is 7 centimeters (cm) (about 2.75 inches) or less in diameter.

Stage II. The cancer is found only in the kidney. The tumor is larger than 7 cm in diameter.

Stage III. In this stage, 1 of the following is true:

• The cancer may have spread outside the kidney. It has spread to 1 or more nearby lymph nodes. The cancer has not spread to distant lymph nodes or distant organs. 
• Cancer has grown into the main blood vessels of the kidney. Or it has grown into the large vein that blood from the kidneys go into (vena cava). It may be growing into nearby tissue, but has not spread to any lymph nodes or into the adrenal gland. It has not spread to distant organs.

Stage IV. In this stage, one of the following is true:

• The cancer has spread outside the tissue covering of the kidney (Gerota's Fascia). Cancer may have also spread to the adrenal gland on top of the kidney. The cancer may be in nearby lymph nodes. It has not spread to distant lymph nodes or organs. 
• The cancer has grown outside the kidney. It has spread to distant lymph nodes and/or other organs. These may include bones, liver, brain or lungs. It may also be found in nearby  lymph nodes. 

Recurrent. Recurrent cancer has come back after it has been treated. It may come back in the original area. Or it may come back in another part of the body.

Talking with your health care provider

When your cancer is staged, your health care provider will talk with you about what the stage means for your treatment. Make sure to ask any questions or talk about your concerns.

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